Healthy for life - Aboriginal community controlled health services: report card

This report card provides information against Essential Indicators from the HfL Program for Aboriginal Community Controlled Health Services (ACCHS) that have participated in the program since 2007 and the 2010-11 OSR data for ACCHS.In addition, background information on the Indigenous population in general are provided from the 2011 Census preliminary estimates and various AIHW reports. The HfL program is funded by the Office for Aboriginal and Torres Strait Islander Health (OATSIH) and has a strong focus on continuous quality improvement. This report card was produced with funding from the National Aboriginal Community Controlled Health Organisation (NACCHO)

Towards a national primary health care strategy: fulfilling Aboriginal peoples aspirations to close the gap

The National Aboriginal Community Controlled Health Organisation (NACCHO) welcomes the Rudd Governments commitment to build a better primary health care system for all Australians through the development of Australia's first National Primary Health Care Strategy. In this submission we provide an important Introduction which sets the context and the definitions that underpin the recommendations for a national primary health care strategy that can best close the gap in life expectancy and health outcomes for Aboriginal peoples. The National Aboriginal Community Controlled Health Organisation believes that the success of a primary health care system should be judged by how effectively, those who are most needy are able to access quality care. The matter is not just about access per se, but also about who is accessing the health system. A strategy that supports health service provision to those who are already good users of the health system will not make gains in health outcomes for Aboriginal peoples. Access to primary health care is identified as a core obligation under the International Covenant for Economic Social and Cultural Rights (ICESCR). Within this core obligation is the understanding that Indigenous peoples have a right to design, deliver and control health services for them in order to achieve health gains. To this end, Australian Governments and non-government institutions have supported Aboriginal primary health care through Aboriginal Community Controlled Health Services (ACCHSs). The Rudd Governments definition of partnership means involving: "Indigenous people in the design and delivery of programs locally and regionally, and share responsibility for outcomes… This strategy is firmly based on the principle of working in partnership with the Aboriginal and Torres Strait Islander community-controlled health sector." The primary health care delivered by Aboriginal community-controlled health services is culturally appropriate because they are: 'An incorporated Aboriginal organisation, initiated by a local Aboriginal community, based in a local Aboriginal community, governed by an Aboriginal body which is elected by the local Aboriginal community, delivering a holistic and culturally appropriate health service to the community which controls it Services that are not Aboriginal community-controlled, by definition, cannot deliver culturally appropriate primary health care. However, services that are not Aboriginal community-controlled can be encouraged to deliver healthcare that is culturally secure. A definition and program prepared by the ACCHS sector for the delivery of Aboriginal cultural safety training for mainstream health services should be supported. NACCHO wishes to impart the message that the Strategy affirm the critical role and impact that accessible and culturally appropriate primary health care can make to close the gap in Aboriginal health standards by 2018 (Rudd Governments Statement of Intent), and for the Strategy to support the required actions needed to realise that objective. In this regard, NACCHO provides numerous recommendations under each of the 10 elements of the Discussion Paper: Towards a National Primary Health Care Strategy. Principal of these recommendations is that ACCHSs are the preferred service model in the delivery of comprehensive primary health care to Aboriginal peoples across Australia. Unless ACCHSs are supported as the key providers in a strategy to close the gap, through an appropriately resourced Capacity Building Plan, the disparities in Aboriginal people's health status will not be alleviated. A systematic framework for working towards a primary health care system for Aboriginal peoples that maximises local community control (such as through a national plan aligned with the Northern Territory Aboriginal Health Forum 'Pathways to Community Control'1) should underwrite a 5 year Capacity Building Plan for ACCHSs. Resourcing pathways to community control for primary health care services will require pooling of all Aboriginal–specific primary health care funds currently being directed to State Governments, Divisions of General Practice and other private health care providers. This will maximize the potential of primary health care to close the gap in life expectancy for Aboriginal peoples. Such fund pooling should be governed by an appropriate mechanism, requiring the involvement of, and endorsement by, the NACCHO Aboriginal leadership. Capacity building will require capital and recurrent funding and workforce strategies to train, recruit and retain staff including measures to address the vast salary disparities which currently prevent staff recruitment within ACCHSs. It will require resourcing based on the model of the Primary Health Care Access Program (PHCAP). A systematic approach towards defining the core deliverables for Aboriginal primary health care services (ie what funding would buy with an acceptable per capita benchmark funding allocation) is needed. ACCHSs funding should be based on a weighted population basis, according to need. A resource allocation formula that reflects the actual cost of ACCHSs providing the agreed core services at particular locations must be agreed to by NACCHO and Affiliates. Progressing such a Plan will require a formalised partnership between the Department of Health and Ageing and the NACCHO leadership, particularly in the form of a new National Framework Agreement. The expert advisory group is encouraged to read the full evidence-based NACCHO submission, but in summary, we draw attention to the following core requirements in order to expand ACCHSs: 1. A long-term plan of action for the expansion of ACCHSs developed in partnership between the Department of Health and Ageing and NACCHO and Affiliates (see Element 1), which meets specified targets and is measured by the indicators identified at the National Indigenous Health Equality Summit (2008) (Element 5). 2. Joint governance of an expansion program based on a National Framework Agreement (see Element 3). 3. The plan to support the adoption of core functions for ACCHSs across Australia (see Elements 2 & 10). 4. A workforce support program (see Elements 2, 8 & 9). 5. An evidence-based, ethical and acceptable quality assurance and performance management program developed by ACCHSs and for ACCHSs (see Elements 5 &6) 6. A funding base for ACCHSs that utilises: • funding on a weighted population basis according to need • pooling of all Aboriginal-specific primary health care funds (including those to State Governments, Divisions of General Practice and other private providers). See Element 10

Towards a national primary health care strategy: fulfilling Aboriginal peoples aspirations to close the gap

The National Aboriginal Community Controlled Health Organisation (NACCHO) welcomes the Rudd Governments commitment to build a better primary health care system for all Australians through the development of Australia's first National Primary Health Care Strategy. In this submission we provide an important Introduction which sets the context and the definitions that underpin the recommendations for a national primary health care strategy that can best close the gap in life expectancy and health outcomes for Aboriginal peoples. The National Aboriginal Community Controlled Health Organisation believes that the success of a primary health care system should be judged by how effectively, those who are most needy are able to access quality care. The matter is not just about access per se, but also about who is accessing the health system. A strategy that supports health service provision to those who are already good users of the health system will not make gains in health outcomes for Aboriginal peoples. Access to primary health care is identified as a core obligation under the International Covenant for Economic Social and Cultural Rights (ICESCR). Within this core obligation is the understanding that Indigenous peoples have a right to design, deliver and control health services for them in order to achieve health gains. To this end, Australian Governments and non-government institutions have supported Aboriginal primary health care through Aboriginal Community Controlled Health Services (ACCHSs). The Rudd Governments definition of partnership means involving: "Indigenous people in the design and delivery of programs locally and regionally, and share responsibility for outcomes… This strategy is firmly based on the principle of working in partnership with the Aboriginal and Torres Strait Islander community-controlled health sector." The primary health care delivered by Aboriginal community-controlled health services is culturally appropriate because they are: 'An incorporated Aboriginal organisation, initiated by a local Aboriginal community, based in a local Aboriginal community, governed by an Aboriginal body which is elected by the local Aboriginal community, delivering a holistic and culturally appropriate health service to the community which controls it Services that are not Aboriginal community-controlled, by definition, cannot deliver culturally appropriate primary health care. However, services that are not Aboriginal community-controlled can be encouraged to deliver healthcare that is culturally secure. A definition and program prepared by the ACCHS sector for the delivery of Aboriginal cultural safety training for mainstream health services should be supported. NACCHO wishes to impart the message that the Strategy affirm the critical role and impact that accessible and culturally appropriate primary health care can make to close the gap in Aboriginal health standards by 2018 (Rudd Governments Statement of Intent), and for the Strategy to support the required actions needed to realise that objective. In this regard, NACCHO provides numerous recommendations under each of the 10 elements of the Discussion Paper: Towards a National Primary Health Care Strategy. Principal of these recommendations is that ACCHSs are the preferred service model in the delivery of comprehensive primary health care to Aboriginal peoples across Australia. Unless ACCHSs are supported as the key providers in a strategy to close the gap, through an appropriately resourced Capacity Building Plan, the disparities in Aboriginal people's health status will not be alleviated. A systematic framework for working towards a primary health care system for Aboriginal peoples that maximises local community control (such as through a national plan aligned with the Northern Territory Aboriginal Health Forum 'Pathways to Community Control'1) should underwrite a 5 year Capacity Building Plan for ACCHSs. Resourcing pathways to community control for primary health care services will require pooling of all Aboriginal–specific primary health care funds currently being directed to State Governments, Divisions of General Practice and other private health care providers. This will maximize the potential of primary health care to close the gap in life expectancy for Aboriginal peoples. Such fund pooling should be governed by an appropriate mechanism, requiring the involvement of, and endorsement by, the NACCHO Aboriginal leadership. Capacity building will require capital and recurrent funding and workforce strategies to train, recruit and retain staff including measures to address the vast salary disparities which currently prevent staff recruitment within ACCHSs. It will require resourcing based on the model of the Primary Health Care Access Program (PHCAP). A systematic approach towards defining the core deliverables for Aboriginal primary health care services (ie what funding would buy with an acceptable per capita benchmark funding allocation) is needed. ACCHSs funding should be based on a weighted population basis, according to need. A resource allocation formula that reflects the actual cost of ACCHSs providing the agreed core services at particular locations must be agreed to by NACCHO and Affiliates. Progressing such a Plan will require a formalised partnership between the Department of Health and Ageing and the NACCHO leadership, particularly in the form of a new National Framework Agreement. The expert advisory group is encouraged to read the full evidence-based NACCHO submission, but in summary, we draw attention to the following core requirements in order to expand ACCHSs: 1. A long-term plan of action for the expansion of ACCHSs developed in partnership between the Department of Health and Ageing and NACCHO and Affiliates (see Element 1), which meets specified targets and is measured by the indicators identified at the National Indigenous Health Equality Summit (2008) (Element 5). 2. Joint governance of an expansion program based on a National Framework Agreement (see Element 3). 3. The plan to support the adoption of core functions for ACCHSs across Australia (see Elements 2 & 10). 4. A workforce support program (see Elements 2, 8 & 9). 5. An evidence-based, ethical and acceptable quality assurance and performance management program developed by ACCHSs and for ACCHSs (see Elements 5 &6) 6. A funding base for ACCHSs that utilises: • funding on a weighted population basis according to need • pooling of all Aboriginal-specific primary health care funds (including those to State Governments, Divisions of General Practice and other private providers). See Element 10

Strong Born—A First of Its Kind National FASD Prevention Campaign in Australia Led by the National Aboriginal Community Controlled Health Organisation (NACCHO) in Collaboration with the Aboriginal Community Controlled Health Organisations (ACCHOs)

The Strong Born Campaign (2022–2025) was launched by the National Aboriginal Community Controlled Health Organisation (NACCHO) in 2023. Strong Born is the first of its kind national Aboriginal and Torres Strait Islander health promotion campaign to address Fetal Alcohol Spectrum Disorder (FASD) within Australia. Strong Born was developed to address a longstanding, significant gap in health promotion and sector knowledge on FASD, a lifelong disability that can result from alcohol use during pregnancy. Utilizing a strengths-based and culturally sound approach, NACCHO worked closely with the Aboriginal Community Controlled Health Organisations (ACCHOs) to develop the campaign through co-design, as described in this paper. Since its inception, the ACCHOs have continually invested in driving change towards improvements in Aboriginal health determinants and health promotion. The Strong Born Campaign developed culturally safe health promotion tool kits designed for the community and health sector staff and also offered communities the opportunity to apply for FASD Communications and Engagement Grants to engage in local campaign promotion. The tool kits have been disseminated to 92 ACCHOs across Australia. This paper describes the development of the Strong Born Campaign and activities following its launch in February 2023 from an Indigenous context within Australia, as described by NACCHO

An Australian national survey of First Nations careers in health services

A strong First Nations health workforce is necessary to meet community needs, health rights, and health equity. This paper reports the findings from a national survey of Australia’s First Nations people employed in health services to identify enablers and barriers to career development, including variations by geographic location and organisation type. A cross-sectional online survey was undertaken across professions, roles, and jurisdictions. The survey was developed collaboratively by Aboriginal and non Aboriginal academics and Aboriginal leaders. To recruit participants, the survey was promoted by key professional organisations, First Nations peak bodies and affiliates, and national forums. In addition to descriptive statistics, logistic regression was used to identify predictors of satisfaction with career development and whether this varied by geographic location or organisation type. Of the 332 participants currently employed in health services, 50% worked in regional and remote areas and 15% in Aboriginal Community-Controlled Health Organisations (ACCHOs) with the remainder in government and private health services. All enablers identified were associated with satisfaction with career development and did not vary by location or organisation type. “Racism from colleagues” and “lack of cultural awareness,” “not feeling supported by their manager,” “not having role models or mentors,” and “inflexible human resource policies” predicted lower satisfaction with career development only for those employed in government/other services. First Nations people leading career development were strongly supported. The implications for all workplaces are that offering even a few career development opportunities, together with supporting leadership by Aboriginal and Torres Strait Islander staff, can make a major difference to satisfaction and retention. Concurrently, attention should be given to building managerial cultural capabilities and skills in supporting First Nations’ staff career development, building cultural safety, providing formal mentors and addressing discriminatory and inflexible human resources policies

Bloodborne viral and sexually transmitted infections in Aboriginal and Torres Strait Islander people: surveillance and evaluation report 2014

This report provides information on the occurrence of blood borne viruses and sexually transmitted infections among Aboriginal and Torres Strait Islander people in Australia for the purposes of stimulating and supporting discussion on ways forward in minimising the transmission risks. Overview Each year, the Aboriginal and Torres Strait Islander Health Program collaborates with the Surveillance and Evaluation Program for Public Health on the “Bloodborne viral and sexually transmitted infections in Aboriginal and Torres Strait Islander people: Surveillance and Evaluation Report”. This surveillance report provides information on the occurrence of blood borne viruses and sexually transmitted infections among Aboriginal and Torres Strait Islander people in Australia for the purposes of stimulating and supporting discussion on ways forward in minimising the transmission risks, as well as the personal and social consequences of these infections within Aboriginal and Torres Strait Islander communities. The Report is produced in a format that is recognised as appropriate for Aboriginal and Torres Strait Islander health services and communities, and is overseen by the National Aboriginal Community Controlled Health Organisation (NACCHO) Sexual Health and Blood Borne Virus Advisory Committee

Defining Australian Indigenous wellbeing: do we really want the answer? Implications for policy and practice

ABSTRACT: Indigenous wellbeing is a current priority for the Australian Government. Given this prioritisation one might be tempted to conclude that a readily accessible and consensual definition of Indigenous wellbeing would be available. Such a definition would be important, for example, in the design and delivery of programmes of psychotherapy that aim to improve wellbeing. A literature review was undertaken to locate such a definition. In particular, the relevance of definitions to Indigenous Australians living in remote communities was of interest. While a small number of definitions are frequently cited in the literature, there is not unanimity in their acceptance. It became obvious that the terms “health” and “wellbeing” are often confused. Sometimes health is included as a component of wellbeing, sometimes wellbeing is included as a subset of health, sometimes the terms are used jointly as in “health and wellbeing”, and sometimes persuasive arguments are made that health and wellbeing are different. The politics of wellbeing is a potent theme in the literature. It seems that the indices of wellbeing that are important to the Government may not always be important to Indigenous Australians. Current Australian Government policy could be seen to be more focused on gently steering Indigenous Australians to adopt a Western style of living rather than providing opportunities for them to live lives of personal meaning and value. This tension may well be a fundamental issue in addressing Indigenous wellbeing.&nbsp

Recent developments in national Aboriginal and Torres Strait Islander health strategy

In this paper I will describe some of the sentinel events in Aboriginal and Torres Strait Islander health policy and strategy during 2003 and the early part of 2004. This will involve discussion on the: • National Strategic Framework in Aboriginal and Torres Strait Islander Health • National Strategic Framework for Aboriginal and Torres Strait Islander Peoples Mental Health and Social and Emotional Well Being 2004–2009 • National Aboriginal and Torres Strait Islander Health Performance Framework • The roll-out of the Primary Health Care Access Program • The National Aboriginal and Torres Strait Islander Social Survey and the National Indigenous Health Survey These developments are consistent with a policy agenda that has evolved, in general terms, since the release of the National Aboriginal Health Strategy in 1989. However, I will also consider significant developments in the broader context for Aboriginal and Torres Strait Islander affairs, particularly the decision made in early 2004 by the Howard government to abolish the Aboriginal and Torres Strait Islander Commission (ATSIC). While the key events and developments that are reported in this paper elaborate on an agenda that has been developing for more than a decade, the decision to abolish ATSIC is likely to have a revolutionary impact on the future development of Aboriginal health strategy

From the margins to the mainstream: deconstructing science communication as a white, Western paradigm

In this commentary we are concerned with what mainstream science communication has neglected through cultural narrowness and ambient racism: other practitioners, missing audiences, unvalued knowledge, unrecognised practices. We explore examples from First Nations Peoples in the lands now known as Australia, from Griots in West Africa and from People's Science Movements in India to help us reimagine science communication. To develop meaningfully inclusive approaches to science communication, we argue there is an urgent need for the ‘mainstream’ to recognise, value and learn from science communication practices that are all too often seen as at ‘the margins’ of this field

An investigation into how Aboriginal Medical Services contribute to childhood immunisation

While there are diverse immunisation service providers, according to the Australian Childhood Immunisation Register (ACIR), less than 1% of all childhood vaccinations (equating to less than 10% of all Aboriginal children) are recorded as being delivered by an Aboriginal Medical Service (AMS). This is likely to be an under-estimate of the care provided. This study sought to determine to what extent AMS’s contribute to the immunisation of Aboriginal children in their local areas. Results The findings revealed that AMS’s in NSW are taking active steps to achieve an improvement in coverage and timeliness of immunisations that occur under NCIP for Aboriginal Children. In addition, the observations revealed various systematic processes in some AMS’s that directly contributed to up to 96% coverage of NCIP vaccines for regular clients. It also highlighted specific program implementation and community events that compliment immunisation through health promotion, reminders and follow up at different AMS’s. Conclusion This study showed that the ‘personality’ and commitment of individual AMS’s contributed significantly to the coverage rates of the children less than 5 years of age in the local areas of the AMS’s that participated in this study. Further investigation is needed to assess data collection at ACIR